Evaluation of National Health Insurance Program Implementation in Jakarta Province, Indonesia

https://doi.org/10.22146/jkki.66063

Evi Susanti Sinaga(1*), Ika Rahma Ginting(2), Rina K Kusumaratna(3), Tiara Marthias(4)

(1) Universitas Trisakti
(2) Universitas Trisakti
(3) Universitas Trisakti
(4) Universitas Gadjah Mada
(*) Corresponding Author

Abstract


The implementation of National Health Insurance in several regions in Indonesia faces challenges, such as health service providers, health insurance management , and the community. The outcome that occurs may vary depending on the implementation of different aspects of governance, equity or social justice, and aspects of service quality. Therefore, research was conducted by evaluating the implementation of the national health insurance in DKI Jakarta Province. The evaluation is carried out based on the 2019 JKN road map target indicators, grouped into three aspects: including governance, achievement of equal distribution of health services (equity), and quality of service. This research used a mixed-methods design that combined the approach of quantitative and qualitative elements. Quantitative data were collected from secondary data from Health Social Security Agency (BPJS Kesehatan), the National Social Security Council Monitoring and Evaluation System (Sismonev DJSN). The qualitative data comes from in-depth interviews with selected informants using the purposive sampling technique. The result was that DKI Province had achieved the JKN membership target. There are still JKN participants who are inactive / in arrears from participants in the government and private wage-earning segments. Health facilities and human health resources have met the standards, but related to the package of benefits for heart diseases services, the availability of cardiac specialists and cath lab facilities has not been evenly distributed, especially in the Seribu Islands. Patient preferences in choosing the desired health service resulted in implementing a tiered referral system and back-referral still having problems in health facilities.

 


Full Text:

PDF


References

1. Putri AE. Seri Buku -4 : Paham JKN (Jaminan Kesehatan Nasional) [Internet]. 2014. 92 p. Available from: http://perpustakaan.bappenas.go.id/lontar/file?file=digital/166156-[_Konten_]-Konten D1726.pdf

2. Presiden RI. UU No. 40 Tahun 2004 Tentang Sistem Jaminan Sosial Nasional. 2015;1–27.

3. Retnaningsih H, Rini T, Lestari P, Yuningsih R, Sholikah N, Suni P, et al. Universal Health Coverage (UHC): Perspektif Kesehatan Dan Kesejahteraan. 2019. 122 p.

4. Mundiharno, Thabrany H. Peta Jalan Menuju Jaminan Kesehatan Nasional 2012-2019. Jakarta: Dewan Jaminan Sosial Nasional; 2012. 1–196 p.

5. Balqis B, Nurhayani N, Geswar RK. Kesiapan Stakeholder dalam Pelaksanaan Program Jaminan Kesehatan Nasional di Kabupaten Gowa. J Adm dan Kebijak Kesehat Indones. 2014;3(01).

6. Irwandy. Kajian Literature : Evaluasi Pelaksanaan Program Jaminan Kesehatan Nasional Di Indonesia. J Kebijak Kesehat Indones JKKI. 2016;05(03):110–4.

7. Badan Pusat Statistik. Kemiskinan DKI Jakarta kembali meningkat. 2021;1–4.

8. Badan Pusat Statistik. Statistik Kesejahteraan Rakyat. Jakarta; 2019.

9. Badan Pusat Statistik Provinsi DKI Jakarta. Statistik Kesejahteraan Rakyat DKI Jakarta 2020. Jakarta; 2020.

10. Shorten A, Smith J. Mixed methods research: expanding the evidence base. Evid Based Nurs [Internet]. 2017 Jul 1;20(3):74 LP – 75. Available from: http://ebn.bmj.com/content/20/3/74.abstract

11. Siddiqi S, Masud TI, Nishtar S, Peters DH, Sabri B, Bile KM, et al. Framework for assessing governance of the health system in developing countries: Gateway to good governance. Health Policy (New York). 2009;90(1):13–25.

12. Kutzin J. Health financing for universal coverage and health system performance: concepts and implications for policy. Bull World Health Organ. 2013;91(8):602–11.

13. BAPPENAS. Penerapan Prinsip-Prinsip Tata Kelola Yang Baik [Internet]. p. 1–4. Available from: https://www.bappenas.go.id/files/4913/5078/6556/15.pdf

14. Schoonenboom J, Johnson RB. How to Construct a Mixed Methods Research Design. Kolner Z Soz Sozpsychol [Internet]. 2017/07/05. 2017;69(Suppl 2):107–31. Available from: https://pubmed.ncbi.nlm.nih.gov/28989188

15. Dinas Kesehatan Provinsi DKI Jakarta. Siaran Pers Dinas Kesehatan Provinsi DKI Jakarta. Jakarta; 2020.

16. DJSN. Aspek Kepesertaan [Internet]. Sistem Monitoring Dan Evaluasi Jaminan Sosial. 2021 [cited 2021 Feb 16]. Available from: http://sismonev.djsn.go.id/kepesertaan/index.php

17. Gubernur Provinsi DKI Jakarta. Peraturan Gubernur Provinsi DKI Jakarta No. 169 Tahun 2016 Tentang Kepesertaan dan Pelayanan Jaminan Kesehatan. Jakarta; 2016.

18. Badan Pengembangan dan Pemberdayaan SDM Kesehatan. Rekapitulasi SDM Kesehatan yang didayagunakan di Fasyankes pada tahun 2015-2019 [Internet]. Kementerian Kesehatan RI. 2021 [cited 2021 Feb 24]. Available from: http://bppsdmk.kemkes.go.id/info_sdmk/history/

19. Menteri Kesehatan RI. Permenkes No. 33 Tahun 2015 Tentang Pedoman Penyususnan Perencanaan Kebutuhan Sumber Daya Manusia Kesehatan. Kementerian Kesehatan RI. 2015.

20. Kepmenko Bidang Kesra. Rencana Pengembangan Tenaga Kesehatan Tahun 2011 – 2025. 2013.



DOI: https://doi.org/10.22146/jkki.66063

Article Metrics

Abstract views : 2636 | views : 8552

Refbacks

  • There are currently no refbacks.


Copyright (c) 2021 Jurnal Kebijakan Kesehatan Indonesia : JKKI

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Jurnal Kebijakan Kesehatan Indonesia : JKKI [ISSN 2089 2624 (print); ISSN 2620 4703 (online)] is published by Center for Health Policy and Management (CHPM). This website is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. Built on the Public Knowledge Project's OJS 2.4.8.1.
 Web
Analytics View My Stats